IEPA 2012

Aims: Indicated prevention was tested for effectiveness in a U.S. nationally representative sample at six sites, at the community, as well as the individual, level. Methods: Among 520 youth aged 12-25 referred by community professionals, 337 met SIPS/SOPS criteria and were assigned to low risk (control condition), clinical high risk or early first episode psychosis (both experimental conditions), in a regression discontinuity design. Controls were those scoring at sum 6 or less on the SIPS Positive Symptom subscale.

Introduction: Anxiety symptoms in patients with schizophrenia have been traditionally overlooked. In the case of First Episode Psychosis (FEP), even fewer studies have examined this association. Current evidence points to the possibility that social anxiety may contribute to poor functional outcome, poor quality of life, unemployment, increased risk for relapse, hospitalization and suicide in FEP.

Background: Results from recent studies suggest that negative symptoms predict transition to psychotic disorder in individuals with an at risk mental state. Aim of the current study was to investigate how negative symptoms are displayed in the daily life of people at ultra-high risk (UHR). Method: Twenty-seven individuals at UHR, 27 schizophrenia patients, and 27 healthy controls were assessed using the Experience Sampling Method (a structured diary technique). This technique allows for the individual to give a moment-to-moment evaluation of the context.

Cognitive behaviour therapy (CBT) for psychosis has traditionally been delivered in addition to antipsychotic medication. However, antipsychotics are frequently associated with severe side effects and do not work for everyone, meaning many people with psychosis choose not to take them and making them unsuitable as an initial intervention for people at high risk of developing psychosis.

Objective: The first five years after psychosis onset represent a high-risk period for suicide in schizophrenia. Detailed assessments of suicidality in first-episode psychosis (FEP) patients will permit more targeted and effective prevention. Method: A sample of 53 patients (mean age 23.3 years, SD 5.5) who were early in the course (DUP median 26 weeks with range 0-101 weeks) of a schizophrenia spectrum disorder were assessed for suicidal intent and behavior with the Columbia Suicide Severity Rating Scale (C-SSRS) over the first year of treatment.

Objective: Early detection in first episode psychosis confers advantages for negative, cognitive and depressive symptoms at 1, 2 and 5 years follow-up. Longitudinal effects are unknown. The objective of this study has been to investigate differences in symptoms and recovery at 10 years between an area with, and an area without early detection. Methods: 281 (early detection: 141, no-early detection: 140) patients aged 18-65 with a first episode of non-affective psychosis were included between 1997 and 2001.

There is a lack of knowledge about the prevalence of prodromal risk syndromes in the community, despite the proposal to introduce a new diagnosis of “Attenuated Psychosis Syndrome” into DSM-V. Thus far, research has been conducted only in the context of individuals attending “prodrome” service or clinic. In order to address this issue, we conducted clinical interviews with 212 adolescents recruited from schools in order to assess for psychotic symptoms, prodromal risk syndromes and other psychopathology.

The traditional approach to studying schizophrenia has been to compare a group of affected individuals with a group of individuals with schizophrenia on a particular measure of interest. However it is not clear whether schizophrenia represents the extreme end of a continuum within the general population or a qualitatively distinct entity. The dimensional model of schizophrenia is predicated on the idea that subclinical or subdiagnostic symptoms of psychosis are relatively common in the population. Why are subclinical psychotic symptoms of interest?

Early intervention in psychosis services (EIS) have been established in the UK for over 10 years and recommended in the UK NICE schizophrenia guidelines. How does the routine provision of EIS compare to these trials and what can we learn from them? We present results from the UK national evaluation of EIS, NATIONAL EDEN, a prospective study of 1027 individuals drawn from 5 sites and over 12 teams. We found that the level of engagement was uniformly high with drop out rate less than the RCTs.

There have been a number of initiatives to reduce DUP in first episode psychosis. In this paper we present the findings of a systematic review by Lloyd-Evans et al (2010, British Journal of Psychiatry). Efforts to replicate the Norwegian TIPS findings have met with mixed results. We argue that this is may be due to the impact of different care pathways within different healthcare systems, which require a tailored approach.